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Bacillary Dysentery (shigellosis)

Bacillary Dysentery (shigellosis). Dept. Of Infectious Disease Wang Jingyan. Definition. Acute infectious disease of intestine caused by dysentery bacilli Place of lesion: sigmoid & rectum Pathological feature: diffuse fibrious exudative inflammation

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Bacillary Dysentery (shigellosis)

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  1. Bacillary Dysentery (shigellosis) Dept. Of Infectious Disease Wang Jingyan

  2. Definition • Acute infectious disease of intestine caused by dysentery bacilli • Place of lesion: sigmoid & rectum • Pathological feature: diffuse fibrious exudative inflammation • Clinical manifestation: fever, abdominal pain, diarrhea, tenesmus , stool mixed with blood, mucus & pus. Even companied with marked toxicity and shock,toxic-encepholopthy.

  3. Etiology • Causative organism: dysentery bacilli, genus shigella, gram-stain negative, short rod,non-motile • Groups: 4 groups & 50 serotypes • - S. Dysenteriae-the most sever • - S. Flexnerii-the epidemic group and easily turn to chronic • - S. Boydii-tropical and subon • - S. sonnei-the most mild

  4. Etiology • Pathogenicity: • - virulence • (endotoxin) - interotoxin (exotoxin) • - invasiveness • (attach-penetrate-multiply) • Resistance: Strong.1-2week in fruits,vegetable and dirty soil. heat for 60℃ 30 min

  5. Epidemiology • Source of infection: • - patients • - carriers • Route of transmission: fecal-oral route • Suceptibility of population:immunity after infection is short and unstead,no cross-immune • Epidemic features: • -season: summer & fall • - Flexneri, Soneii, dysentery • - age: younger children

  6. Pathogenesis • Number of bacteria • toxicity • immunity • invasiveness • -attachment • - penetration • - multiplication

  7. Pathogenesis-common Bacteria intestine Penetrate mucus Normal bacteria flora sIg A Multiply in epithelia cell & proper lamina Prevent attaching endotoxin Inflammation vessel contraction Endogenous pyrogen fever Superficial mucosal in,nec and ulcer Diarrhea mixed with blood & pus, abdominalache

  8. Pathogenesis-toxic Strong - allergy to endotoxin Demethyl-adrenaline Micro-circulatory failure Shock, DIC, cerebral edema cerebral hernia

  9. Pathology • Site of lesion: entire large bowel-colone, sigmoid & rectum • Feature: • acute: diffuse fibrinous exudative inflammation, hyperemia, edema, leukocyte infiltration, superficial necrosis • chronic: edema, polypoid hyperplasis • toxic: endothelial cell of micro-capillary necrosis

  10. Clinical manifestation • Incubation period: 1-2 day, (Hrs. To 7 days) • Acute dysentery • common type: • onset in sudden, shiver, high fever • abdominal pain • diarrhea:stool mixed with blood, mucus & pus • tenesmus, continence

  11. Clinical manifestation • Acute dysentery • mild type: • caused by S. sonnei • low fever or no fever • Abdominal pain is mild • stool mixed with mucus, without blood & pus • diagnosis by isolation bacteria

  12. Clinical manifestation • Acute dysentery: Toxic type: • Age: 2 to 7 yrs. • Abrupt onset, high fever, Trise to 40oC • Listlessness,lethargy,convulsion,coma. • circulatory & respiratory collapse • diarrhea mild or absent at beginning • shock form: septic shock • brain form: respiratory failure • mixed form

  13. Clinical manifestation • Chronic dysentery: > 2 months • Chronic delayed type:diahhrea long-time and repeated • Chronic obscure type: acute history in 1 year, no symptoms, stool culture Pos. or sigmoidscopy • Acute attack type: same as common acute dysentery

  14. Laboratory Findings • Blood picture: total WBC count increase, • neutrophils increase • Stool examination: • direct microscopic exam.: WBC, RBC, pus cells • bacteria culture: • Sigmoidoscope: shallow ulcer,scar, polyps

  15. Differential diagnosis • Acute dysentery • Amebic dysentery • Entameba histolytica • stool: reddish brow, like jam • flask-shaped ulcer,Amebic trophozoite • Enteritis caused by E. Coli, salmonella,viral diarrhea • Intussusception: jelly-like stools, abdominal mass and absence of fever

  16. Differential diagnosis • Chronic dysentery • Rectal & colonic carcinoma: no cure for long-term,drop of weiht of body • non-specific ulcer colitis: no cure for long-term,culture of stool is negetive, sigmoidoscope:hemorrhage,ulcer,lead pipe. • Chronic schistosomiasis Japonica a. co ntact with the disease-water b. hepatomegaly and splenomegaly c .founding the ova of schistosomiasis Japonica

  17. Toxic dysentery • Encephalitis B brain form:Japaness B encephalitis a.stool b.CFS-IgM c.slowly d.shock rarely

  18. Treatment • Common dysentery • Toxic dysentery • general treatment • Pathogenic treatment :ofloxine or Amp. Given by IV • Synptomatic treatment:Control high fever, convulsion: sub-winter sleep • Treatment of shock:same as ECM • Treatment of cerebral edema: same as EBC

  19. Treatment • Chronic dysentery • General therapy:live,nurishing,diet,avoid overwork,excise. • Etiologic therapy: sensitive antibiotics used in turn or combined use;according to results of culture;enema;expectant treatment.

  20. Prevention • Control the source of infection: until culture negative • Interruptted the route of transmission: method of mainly • Protct the susceptability:F2a-secratory IgA protect 80%-6-12mon • return

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